CoChat
Sign Up
Cited by 1,215Palliative Care and End-of-Life IssuesEthics and bioethics in healthcareEthics and Legal Issues in Pediatric Healthcare

The DOI matches its Crossref record; 28 of the 28 references it cites were found in a registry or an index.

Medical Futility: Its Meaning and Ethical Implications

Schneiderman, Lawrence J., Jecker, Nancy S., Jonsen, Albert R.·1990·Annals of Internal Medicine
DOI 10.7326/0003-4819-112-12-949
Open this paper in CoChat — free account

Abstract

The notion of medical futility has quantitative and qualitative roots that offer a practical approach to its definition and application. Applying these traditions to contemporary medical practice, we propose that when physicians conclude (either through personal experience, experiences shared with colleagues, or consideration of published empiric data) that in the last 100 cases a medical treatment has been useless, they should regard that treatment as futile. If a treatment merely preserves permanent unconsciousness or cannot end dependence on intensive medical care, the treatment should be considered futile. Unlike decision analysis, which defines the expected gain from a treatment by the joint product of probability of success and utility of outcome, our definition of futility treats probability and utility as independent thresholds. Futility should be distinguished from such concepts as theoretical impossibility, such expressions as "uncommon" or "rare," and emotional terms like "hopelessness." In judging futility, physicians must distinguish between an effect, which is limited to some part of the patient's body, and a benefit, which appreciably improves the person as a whole. Treatment that fails to provide the latter, whether or not it achieves the former, is "futile". Although exceptions and cautions should be borne in mind, we submit that physicians can judge a treatment to be futile and are entitled to withhold a procedure on this basis. In these cases, physicians should act in concert with other health care professionals, but need not obtain consent from patients or family members.

Overview

Integrity signals

Registry

Crossref · 10.7326/0003-4819-112-12-949

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Show all 28 references

Research works printed but not linked: 10

  1. . Deciding to Forego Life-Sustaining Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment Decisions. Washington DC: U.S. Government Printing Office; 1983:60-89.
  2. Jonsen A, 1987, Pharos., 50, 4
  3. Lo B, 1989, The Meaning of AIDS, 1, 86
  4. Weinstein M, 1980, Clinical Decision Analysis.
  5. Jonsen A . The Old Ethics and the New Medicine. Cambridge: Harvard University Press; 1990.
  6. 1977, Ethics in Medicine: Historical Perspectives and Contemporary Concerns., 6
  7. 1981, Republic., 76
  8. Plum F, 1980, The Diagnosis of Stupor and Coma.
  9. Katz J, 1984, The Silent World of Doctor and Patient.
  10. Jecker N, 1990, J Clin Med.

Cited by

Sorted by citations

Items 501–600 of 1,000

Related

See all

Metadata

Authors
Schneiderman, L. J., Jecker, N. S., & Jonsen, A. R.
Affiliations
University of California San Diego (US)
Corresponding author
Schneiderman, Lawrence J.
ORCID
Jecker, Nancy S.
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
1990-06-15
Volume
112
Issue
12
Pages
949-954
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-112-12-949
OpenAlex
W2067149985
Cited by
1,215
References
28
Citations by year
2026: 28 · 2025: 29 · 2024: 46 · 2023: 35 · 2022: 38 · 2021: 36 · 2020: 41 · 2019: 55 · 2018: 40 · 2017: 33 · 2016: 39 · 2015: 43 · 2014: 39 · 2013: 44 · 2012: 41
FWCI
15.39
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
Keywords
futility, treatment decision-making, withholding treatment, decision analysis, physician judgment, informed consent, end-of-life care
MeSH terms
Critical Care, Ethics, Medical, Euthanasia, Passive, Family, Humans, Patient Participation, Philosophy, Medical, Physician's Role, Probability, Risk Assessment, Patient Selection, Personal Autonomy, Paternalism, Moral Obligations, Withholding Treatment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review